Outpatient High-Density Silicone Oil Removal From the Anterior Chamber Using Air

Dear Editor,

The appearance of silicone oil in the anterior chamber leads to corneal decompensation, cataract, and glaucoma. Several operative techniques have been reported, such as the use of hyaluronate sodium ¹ to passively expulse the oil, an air-infusion system, and a silicone oil extractor with use of a side air pump with simultaneous aspiration of the oil. ² In situations in which silicone oil has migrated into the anterior chamber soon after surgery, it would be ideal to have it removed without returning to the operating room and without further silicone oil prolapsing forward into the anterior chamber from the vitreous cavity. ³

Our technique is performed in an outpatient clinic at the slit lamp using topical anesthesia (Figure 1). The study received institutional review board approval from Rafic Hariri University Hospital. After obtaining the patient’s consent, a drop each of topical proparacaine and 5% polyvidone iodine are instilled. A sterile eyelid speculum is inserted. A standard 25-gauge needle is entered at 6 o’clock. The anterior chamber is completely filled with air using repeated limbal (temporally) injections with a 30-gauge needle. The aqueous fluid is not aspirated. The 6 o’clock wound is gaped by pressing on its posterior lip, allowing passive egress of the oil. Intracameral injection of air is repeated until complete egress of oil. The technique takes approximately 10 to 12 minutes (depending on the volume of the silicone oil bubble) as oil trickles slowly drop by drop. The technique was successful in complete removal of high-density silicone oil from the anterior chamber in 3 eyes of 3 patients. The same technique was also successful in the removal of 1200 centistokes of silicone oil from the anterior chamber in 1 patient.

Figure 1.

(A) A large, inferior high-density silicone oil bubble (yellow) is seen at slit lamp. (B) The anterior chamber is completely filled with air using a 30-gauge, 0.5-mL syringe through a temporal paracentesis with consequent rise in intraocular pressure. (C) The 6 o’clock limbus is entered with a 25-gauge needle and the posterior wound lip is pressed to allow egress of oil. (D) Additional air is injected until oil is emptied from the anterior chamber.

To the best of our knowledge, only 2 publications have described silicone oil removal from the anterior chamber in an outpatient setting. First, Soliman and Smiddy ³ removed silicone oil in eyes with high intraocular pressure (IOP) via a temporal paracentesis with a 19-gauge needle that functioned as a conduit by which the oil passively egressed out of the anterior chamber. Second, Iaboni et al ⁴ injected dispersive viscoelastic and allowed silicone oil to passively egress through a 1-mm corneal limbal incision at 12 o’clock while placing gentle pressure with the cannula on the posterior lip of the corneal wound to allow the wound to gape and facilitate silicone oil egress.

One problem with this technique is the risk of raising IOP. Our technique is performed using the slit lamp with the patient sitting and can be applied to both high-density and regular silicone oil (as well as perfluorocarbon liquid) because air displaces regular silicone oil inferiorly. The overfill of the anterior chamber with air leads to increased IOP that drives out the oil passively through a gaping inferior wound. Passive egression of oil with this technique is a slow process but is much safer than the faster active aspiration with a vitrector (under high-suction mode) of high-density silicone oil that can lead to Descemet detachment. ⁵